Staging and grading of periodontitis: Framework and proposal of a new classification and case definition

Tonetti, Maurizio S.; Greenwell, Henry; Kornman, Kenneth S.

doi:10.1111/jcpe.12945

Cited by 888 publications

(1,057 citation statements)

References 76 publications

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“…Patients were recruited from February 2015 to March 2016 at the University Clinic of Dentistry, Medical University of Vienna, after initial periodontal screening. The inclusion criteria, with regard to the new classification of periodontitis, were as following: localized or generalized periodontitis of periodontal stage II, III, or IV with grades B or C, age of >35 years with probing depths >5 mm in at least one site in each quadrant, radiologically detectable alveolar bone loss in all quadrants and good general health. Exclusion criteria were current pregnancy, systemic or local antimicrobial treatment in the last 6 months, periodontal treatment in the last 6 months, the presence of an infectious disease, chronic pulmonary disease, cancer, or diabetes and other apparent oral infection, intake of immunosuppressive medication or immunodeficiency.…”

Section: Methodsmentioning

confidence: 99%

“…The activation and extent of periodontal destruction is determined on the one hand by the quantity and virulence of the bacteria, on the other by the response of the host (immune status, genetics) . Three forms of periodontitis can be distinguished, based on pathophysiology: necrotizing periodontitis, periodontitis as a direct manifestation of systemic diseases and periodontitis . Conservative periodontal treatment offers a very efficient reduction in microbial count and also improves clinical parameters .…”

Section: Introductionmentioning

confidence: 99%

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Photoactivated disinfection in periodontal treatment: A randomized controlled clinical split‐mouth trial

Husejnagic

Lettner

Laky

et al. 2019

Journal of Periodontology

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Background Photoactivated disinfection (PAD) could support the periodontal treatment outcome. The effect of the light emitting diode (LED) as an innovative light source in PAD is under discussion. The aim of this study was to evaluate the clinical and microbiological effect of adjunctive PAD in the treatment of periodontitis with a red LED as light source. Methods Twenty patients with periodontitis completed this split‐mouth study. The left and right side of the jaws were randomly assigned to either test or control group. After conservative periodontal treatment in both groups, the test group received two sessions of adjunctive PAD (red LED, 635 nm, photosensitive dye, 0.01% tolonium chloride), whereas the control group received no adjunctive PAD. The parameters of clinical periodontal examination—including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and microbiological assays (PCR) were evaluated before and after treatment. Results After 3 months, both treatment groups showed significant improvements regarding BOP, PD, and CAL compared to baseline, with no significant difference between control and treatment group. The recolonization of Porphyromonas gingivalis and Treponema denticola was reduced after adjuvant treatment, but not significantly. Conclusions The positive effect of adjunctive PAD regarding clinical parameters was reported in recent trials. In this study and with the current settings, both treatment groups showed similar clinical results after initial periodontal treatment, without beneficial effect of adjunctive PAD.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Photoactivated disinfection in periodontal treatment: A randomized controlled clinical split‐mouth trial

Husejnagic

Lettner

Laky

et al. 2019

Journal of Periodontology

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“…Likewise, studies with hydroxyapatite (HA) containing oral care products reported anti‐adhesive effects, but observed no specific antimicrobial effects of the hydroxyapatite particles in situ . To evaluate those different formulations under clinical conditions, a randomized controlled study was conducted with stage I and II periodontitis patients using either a HA‐ or an AmF/SnF 2 ‐containing toothpaste for 12 weeks while receiving periodontal therapy . Results of this study showed no differences between toothpastes in reducing the visible plaque on teeth or interfering with the de novo plaque formation.…”

Section: Introductionmentioning

confidence: 99%

No differences in microbiome changes between anti‐adhesive and antibacterial ingredients in toothpastes during periodontal therapy

Hagenfeld

Prior

Harks

et al. 2019

J of Periodontal Research

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Aim This subgroup analysis of a 12‐week randomized, double‐blind, and two‐center trial aimed to evaluate whether two different toothpaste formulations can differentially modulate the dental microbiome. Material and Methods Forty one mild to moderate periodontitis patients used as an adjunct to periodontal treatment either a toothpaste with anti‐adhesive zinc‐substituted carbonated hydroxyapatite (HA) or with antimicrobial and anti‐adhesive amine fluoride/stannous fluoride (AmF/SnF2) during a 12‐week period. Plaque samples from buccal/lingual, interproximal, and subgingival sites were taken at baseline, 4 weeks after oral hygiene phase, and 8 weeks after periodontal therapy. Samples were analyzed with paired‐end Illumina Miseq 16S rDNA sequencing. The differences and changes on community level (alpha and beta diversity) and on the level of single agglomerated ribosomal sequence variants (aRSV) were calculated with analysis of covariance (ANCOVA) and likelihood ratio test (LRT). Results Interproximal and subgingival sites harbored predominately Fusobacterium and Prevotella species associated with periodontitis, whereas buccal/lingual sites harbored mainly Streptococcus and Veillonella species associated with periodontal health. Alpha and beta diversity did not change noticeably differently between both toothpaste groups (P > 0.05, ANCOVA). Furthermore, none of the aRSVs showed a noticeably different change between the tested toothpastes during periodontal therapy (Padj .> 0.05, LRT). Conclusion The use of a toothpaste containing anti‐adhesive HA did not induce statistically noticeably different changes on microbial composition compared to an antimicrobial and anti‐adhesive AmF/SnF2 formulation.

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“…The main strengths of the present study are a larger sample size compared with previous studies, analysis of association with disease severity measured as PD ≥5 mm and sub‐analysis in AgP and CP. This showed no differences in leukocyte and erythrocyte parameters between these now obsolete disease entities, supporting the concepts that led to the elimination of AgP‐CP differentiation in the new classification . Important limitations are that no serum iron levels were studied and that this was a secondary analysis of studies not powered to test differences in erythrocyte and leukocyte parameters.…”

Section: Discussionmentioning

confidence: 56%

Anemia of inflammation associated with periodontitis: Analysis of two clinical studies

Nibali

Darbar

Rakmanee

et al. 2019

Journal of Periodontology

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Background While leukocytosis is a common feature of severe periodontitis, a smaller amount of evidence has been produced on erythrocytes counts in periodontitis, suggesting a possible tendency to anemia. The aim of this study was to investigate the associations between periodontitis and circulating leukocytes, erythrocytes, and platelets. Methods The study included 471 patients with periodontitis (including aggressive periodontitis [AgP], and chronic periodontitis [CP]) and periodontal health. A separate sample of 333 patients from a previous study (127 AgP and 206 periodontally healthy) was used as replication. Periodontal clinical data were collected and a blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes and platelets. Results Adjusted linear regression analyses revealed associations between periodontitis and total leukocytes counts (p < 0.001), neutrophil counts (P <0.001) and hematocrit (HCT) levels (P = 0.045). Sub‐analysis revealed no statistically significant differences between AgP and CP. Disease severity was correlated with total leukocyte and neutrophil counts and HCT (P <0.001, P <0.001 and P = 0.004, respectively). In the replication sample, adjusted linear regression analysis revealed associations between periodontitis and decreased hemoglobin (HB) (P = 0.009), mean corpuscular hemoglobin (MCH) (P = 0.023), and MCH concentration (P <0.001). A subset of patients included in these studies (14% to 15.7% of periodontitis versus 8.4% to 10.2% of healthy, respectively, in the two cohorts) were anemic based on the World Health Organization criteria. Conclusion This paper, reporting results of periodontal examination and blood sampling in over 800 patients, suggest that not just leukocytosis but also tendency to “anemia of inflammation” are typical features of periodontitis.

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Staging and grading of periodontitis: Framework and proposal of a new classification and case definition

Cited by 888 publications

References 76 publications

Photoactivated disinfection in periodontal treatment: A randomized controlled clinical split‐mouth trial

Photoactivated disinfection in periodontal treatment: A randomized controlled clinical split‐mouth trial

No differences in microbiome changes between anti‐adhesive and antibacterial ingredients in toothpastes during periodontal therapy

Anemia of inflammation associated with periodontitis: Analysis of two clinical studies

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